Google’s new mental health tool is a good idea. But there’s more work to do.

Google has just come out with a mental health tool for those who query “depression” on its site. The Patient Health Questionnaire 9 (PHQ-9) is a series of nine questions that help assess depression symptoms. Doctors use it when screening for depression and use the results in conjunction with additional history from the patient to make (or not make) a diagnosis of Major Depression. Now anyone can access this same questionnaire on Google but is preemptively “encouraged to  talk to a care provider or doctor about what your score may mean for your overall health.” A link to the National Suicide Prevention Lifeline is also provided.

Depression, recently reported to be the world’s most widespread illness, has far-reaching implications when left untreated: from strain on personal relationships to disability and worsening of chronic conditions to an economic cost to society. As an internist, I saw many patients who were never diagnosed but wondered if they had depression. Some sought help even when their spouses or parents didn’t “believe” in depression and told them to “think positive” or “get over it.” I am thankful for those in the public sphere who bravely share their mental health struggles and help remove the stigma of mental health issues. And I applaud Google for designing a way to bring additional awareness to its users.

Google’s PHQ-9 feature is just a first step, however. Those who search the term “depression” likely represent a population who suspect or have been told they might have this diagnosis. But bringing awareness to the completely unaware is where the greatest impact can be made. I can’t count the number of times that patients have said – after diagnosis and when their depression is better controlled – that in retrospect, they likely had depression for many years and just didn’t realize it.  With platforms like Google, Facebook, Twitter and Instagram plus advancements in AI, we just might see that awareness occur sooner.



Is There Pressure to be Informed?

I recently had the opportunity to speak to employees of King County, WA about finding credible health information online. During the Q&A a few interesting questions were posed (rephrased here):

  1. Does my doctor expect me to have looked up my symptoms online?
  2. Does it help my doctor get to the diagnosis faster if I look my symptoms up online and come up with diagnoses, as well?

The person who asked question #1 told a story about reviewing some symptoms with his doctor at an appointment and being taken aback when his the doctor asked him, “And what did you find on the internet?” The patient had indeed looked up his symptoms online, and was surprised that his doctor knew. However, he was left wondering if he was actually expected to research his symptoms online before his appointments.

The second question is actally a good question that I had not considered but makes sense when looking at it from a patient’s perspective. Should patients do some “homework” prior to their appointments to help a doctor get to a diagnosis faster?

Regarding question number one, I often ask if there was something my patient thought he/she might have in order to make sure I address some concern that might be otherwise left unspoken during the visit. But I do not have an expectation that patients come in having “researched” their symptoms.

My answer to question #2 is based only on personal experience. It does not necessarily help me get to a diagnosis faster if a patient looks up his/her symptoms online. I have certainly had some patients who were able to come up with diagnoses that were correct. More often than not, though, the scenario in my office is one where a patient is concerned about the worst possible outcome (which, luckily, is not often the actual case). Then there are others who may have figured out their diagnoses but never mentioned it. As I do not have a well-studied answer to this question, I am open to hearing from physicians who might have had a different experience. That being said, I would not discourage a patient from using his own resources to find out more about his symptoms. However, he should keep in mind that after a detailed history (which is the part of the visit where the doctor gathers information from a patient’s story) and exam, the diagnosis could be very different depending on the actual details elicited and findings observed.

These two questions from the audience, however, brings to light our changing roles in healthcare. Certainly, the doctor-patient relationship has undergone yet another evolution with the concept of the e-patient, distant now from its paternalistic beginnings. But, in the midst of (at the end of?) the Information Age and, perhaps, heading into an “Understanding Age,” are there now new expectations placed on patients by others or by themselves?  Is there a certain degree of pressure to be an informed patient on those who may or may not be comfortable synthesizing this type of information? Is there an expectation that one knows everything about his/her own medical condition? Is there more pressure involved in just being a patient today? Sometimes, I think there is.

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The Doctor Will Really See You Now

“All the world’s a stage, and all the men and women merely players.”

– William Shakespeare

In our respective tragedies/comedies (depending on the moment), some individuals are better actors, revealing and hiding emotions with relative ease, portraying exactly the “I” that is scripted in their minds. Others, such as those who turn red at the slightest bit of discomfort, may try as they might but eventually have to give in to the transparency of their physiology.

Well, the playing (acting) field may have just been evened.

MIT’s Media Lab has engineered a remarkable pair of glasses “that are set to transform how we interact with each other” by accurately detecting very subtle facial cues that would be otherwise missed. The initial concept was born with the intention of helping people with autism pick up on these cues.

Inside the glasses is a camera the size of a rice grain connected to a wire snaking down to a piece of dedicated computing machinery about the size of a deck of cards. The camera tracks 24 “feature points” on your conversation partner’s face, and software developed by Picard analyses their myriad micro-expressions, how often they appear and for how long. It then compares that data with its bank of known expressions(see diagram).

From New Scientist

Roger Ebert (on Twitter) says, “These spectacles could destroy social life as we know it. And diplomacy.” But just imagine the possibilities within a doctor-patient interaction if a doctor could more easily detect skepticism or hope or fear or frustration. Perhaps, the use of these “social x-ray specs” would be limited in the case of a highly botox-ed face, but for the majority of patients, it could potentially enhance doctor-patient communication.

So, I say, “Where can I get one of these?”

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